Garbellini, S., Parsons D., & Imms, C., (accepted Jan 2025).

Plain language summary:

Introduction

Managing hand deformities of people living with neurological impairment can be challenging. Experienced clinicians can find it hard to determine the best ways to manage them. Orthoses have been used to manage hand deformity but their use is somewhat controversial and evidence to support their use is limited. The Neurological Hand Deformity Classification (NHDC) is a framework that can help clinicians identify the wrist and hand muscles that cause hand deformities and guide the choice of treatment, which sometimes includes the use of wrist and hand orthoses. This study uses real-world cases to show how the NHDC can guide clinical decisions on the use of orthoses for people living with neurological hand deformities.    

Methods

The detailed descriptions of past cases were used to demonstrate how the NHDC could be used to aid orthotic decision-making. The framework provided structure to: 

• observe and classify the dynamic movement of the wrist and hand muscles
• identify the dynamic forces causing hand deformity 
• guide decision making for intervention strategies to address deforming forces, such as wrist and hand orthoses. 

Results 

 The results discuss:

• the identification of the wrist and hand muscles involved in causing the deforming forces 
• how the NHDC guided the orthotic intervention to resolve the deforming forces. 

Context is provided regarding the reason, purpose, and description of the orthoses used, and timing and dosage of wear is outlined. 

Conclusion  

The NHDC can be used as part of a comprehensive upper limb assessment. It can inform intervention decisions including upper limb orthotic intervention.